MEDICARE: DR. DWIGHT ERWIN JENNINGS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	25914	CA

General Provider Information

NPI Number	:	1104025808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWIGHT ERWIN JENNINGS DDS

Provider Business Mailing Address
First Line	:	2187 HARBOR BAY PARKWAY
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94502-3019
Country	:	US
Telephone Number	:	510-522-6828
Fax Number	:	510-522-0877

Provider Business Practice Location Address
First Line	:	2187 HARBOR BAY PARKWAY
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94502-3019
Country	:	US
Telephone Number	:	510-522-6828
Fax Number	:	510-522-0877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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